OnCore Nutrition - Two Peas in a Podcast

Episode 21: IBS and tips for a less irritable gut ft. special guest Dr Carly Ymer

Episode Summary

Irritable bowel syndrome is a complex and challenging condition. This week we;ll explore dietary strategies and ask the experts about the mind-gut connection.

Episode Notes

Causes and triggers

Brain-gut axis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/pdf/AnnGastroenterol-28-203.pdf
Gut microbiome - https://onlinelibrary.wiley.com/doi/full/10.1111/apt.12728
Environmental factors
Post infection - (e.g. gastroenteritis infection or campylobacter pylori)
Beatty JK, Bhargava A, Buret AG. Post-infectious irritable bowel syndrome: mechanistic insights into chronic disturbances following enteric infection. World J Gastroenterol. 2014;20(14):3976-3985.
Enck P, Aziz Q, Barbara G, et al. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014.
Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009;15(29):3591-3596.
Thompson JR. Is irritable bowel syndrome an infectious disease? World J Gastroenterol. 2016;22(4):1331-1334.

Investigations and Diagnosis:

Blood tests, stool samples, family history, colonoscopy, gastroscopy
Hydrogen Breath Tests

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgh.13689

http://shepherdworks.com.au/fodmaps-breath-testing-are-you-blowing-your-money/

Rome Criteria

https://irritablebowelsyndrome.net/clinical/new-rome-iv-diagnostic-criteria/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704116/#!po=31.2500

Dietary interventions

Low FODMAP diet (Fermentable, Oligosaccharides, Disaccharides,Monosaccharides and Polyols)
- Management: 6-8 week elimination diet and slow reintroduction (under close guidance from a DT)
Fibre
- Soluble vs Insoluble - depends on your symptoms.
- Soluble fibre (e.g., psyllium husk) may assist in the management of IBS and can improve symptoms of patients.
- Supps may cause bloating - important to introduce this gradually.
Probiotics/Prebiotics
- Some evidence for use of probiotics in the context of GIT infections and diarrhoea. About 7–30% of patients with infectious diarrhoea can develop IBS. Probiotics may help to improve the barrier that lines our gut.
- There is no specific probiotic that is recommended. If you choose a probiotic, take the same strain and dose for 4-weeks. If you feel better, continue with the same probiotic. If you do not feel better after 4-weeks, try a different dose or strain. We can guide you where to start depending on your Sx.

Summary: Diets for the treatment of IBS symptoms are complex and multifactorial. Due to huge amounts of patient variation in severity of symptoms and intolerances, it can challenge to point point an exact method.

Many different diets have been studies in the treatment of IBS, however there have been huge limitations in many of those published. At present the diet with the best level of evidence is the elimination diet (low fodmap and reintroduction) under the guidance of an APD.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2036.2004.02267.x

Medical management references:

American Gastroenterological Association Institute Technical Review on the Pharmacological Management of Irritable Bowel Syndrome- https://www.gastrojournal.org/article/S0016-5085(14)01090-7/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291563/
American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome - https://www.gastrojournal.org/article/S0016-5085(14)01089-0/fulltext

Dr Carly Ymer

Dr Carly Ymer is a clinical psychologist who practices holistic psychotherapy, using her passion for mental and emotional wellbeing to help clients be their best. She believes and practices within an integrative and holistic framework of the synergy between thinking, emotions, and behaviour. Carly is passionate about working with children, teenagers and young adults, with a range of emotional, social and behavioural difficulties.

https://beingwellclinic.com/